Any risks when going to the dentist while on Imbruvica?

[AshGS]

As I heard that Imbruvica works as a blood thinner

[HailMary-USA]

Hello Ash. Sharing what I’ve learned as a CLL patient on Calquence, which is in the same drug class as Ibrutinib:

Routine dental exams and hygiene/ cleaning should not pose a bleeding problem.

For a recent molar extraction, my hema-onc doc advised me to suspend Calquence for 3 days prior to the procedure and 7 days after.

This was when I had been on the drug for 5 months. A ten day suspension was deemed to have no risk of adverse repercussions.

In fact, the labs I had drawn one week post procedure showed continuing improvement in blood results.

There were no excessive bleeding issues beyond normal, which was frequently changing gauze for the first few hours.

But also be aware of your personal infection risk level.

My dentist prescribed a week of antibiotics, starting 3 days prior to procedure.

He also gives me a 2000mg “pulse” of Amoxicillin antibiotic prior to Every appointment, but this is mainly due to my heart valve disease. I appreciate that he is old-school and very conscientious.

Best wishes to you from Mary.

[AshGS in reply to HailMary-USA]

Thanks much Mary.. This is very informative!I understand then that my understanding that Imbruvica works as a blood thinner that I wouldn't need to stay on a blood thinner for long after Covid??

[HailMary-USA in reply to AshGS]

I’m sorry I can’t speak to issues of COVID and/or blood thinners.

Someone knowledgeable here will probably reply.

[AussieNeil Partner Administrator in reply to HailMary-USA]

Ash, further to Mary's reply, this is a question for your respective specialists. It's a bit of a simplification to say that "Imbruvica works as a blood thinner". More correctly, our platelets also contain a tyrosine kinase enzyme and through that platelet enzyme Imbruvica has an off target impact on clotting effectiveness. Later generation BTKi drugs are more targeted, so there's less of an effect.

Neil

[AshGS in reply to AussieNeil]

Thanks much Neil! Good day

[onu1tadi2 in reply to AussieNeil]

I am not sure I understand what you are saying. I am confused as to the blood thinning properties of Calquence and the thinners prescribed to prevent clogs for people who have Arrhythmia. My doctor said they are different type of blood thinners, whatever that means. I am not taking the blood thinners prescribed because my Afib only happens occasionally when I eat too much salt or spend too long on computer and am stressed. So I try to control it. Happens once a month or so. but am concerned.

[AussieNeil Partner Administrator in reply to onu1tadi2]

In other words BTKi drugs increase the risk of bleeding and bruising, because:-

1) platelets don't clot as well due to these drugs

2) Platelet counts can be lower due to the effect of the BTKi on the bone marrow, often not helped by CLL already causing a low platelet count from bone marrow infiltration and/or causing a swollen spleen, which filters more out.

That's why it's fairly common to experience petechiae and bruising, at least initially, when on BTKi drugs.

[rcusher]

Hi there, I have been on Ibrutinib for 4 years now and all is good. Twice I have had to have dental surgery to remove some teeth. I was told by my Oncologist/Haematologist to stop taking Ibrutinib 3-5 days before the surgery and 3 days after. Both times I have started an antibiotic the day before and for at least 7 days after. And all I can say other the the tooth extractions I had no problems. My bloodwork stayed the same.

[AshGS in reply to rcusher]

Thanks much dear!

[stevesmith1964]

Stop 5 days before and 5 days after dentist

[onu1tadi2]

I was told by my hematologist to go off calquence 2 days early for any dental work. In my case I am having some extractions. I plan to go off for at least 3 days before. I also take blood pressure pills but they do not pose a problem. Extractions apparently do not cause major bleeding, and are not complicated. A root canal is more complicated, but probably not much bleeding.